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Pneumocystis pneumonia — RCPSC IM MCQ

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HardInfectious DiseasesPneumocystis pneumoniaRCPSC IM

A patient with cirrhosis becomes disoriented with asterixis after constipation and recent sedative use. There is no shock, bleeding or focal neurologic deficit. What is the best initial management?

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Correct answer: C — Correct precipitants and titrate lactulose with airway monitoring

The best answer is “Correct precipitants and titrate lactulose with airway monitoring”. Hepatic encephalopathy is treated clinically by correcting precipitants and titrating lactulose to regular soft stools, with airway protection when consciousness is impaired. Ammonia does not govern treatment, and sedatives, overdiuresis or unrelated immunosuppression can worsen the syndrome.

Reference: Cirrhosis Care, treatment-provider resources: https://cirrhosiscare.ca/treatment-provider/